Zhang, Y., Yang, Y., Zhang, Z., Fang, W., Kang, S., Luo, Y., . . . Zhang, L. (2016). Neurokinin-1 receptor antagonist-based triple regimens in preventing chemotherapy-induced nausea and vomiting: A network meta-analysis. Journal of the National Cancer Institute, 109, djw217. 

DOI Link

Purpose

STUDY PURPOSE: To compare the effects of different regimens of NK1-based antiemetic treatment for patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC)

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, Embase, Cochrane Collaboration
 
INCLUSION CRITERIA: Randomized, controlled trial (RCT) or prospective study evaluating NK1-based triple-drug therapy for chemotherapy-induced nausea and vomiting (CINV) using standard NK1 dosages; efficacy and toxicity measures were available.
 
EXCLUSION CRITERIA: None specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,796

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 35 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 18, 889
  • SAMPLE RANGE ACROSS STUDIES: 16–1438
  • KEY SAMPLE CHARACTERISTICS: All were receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) treatment regimens.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Regimens using various NK1s showed equivalent antiemetic effect in the overall, acute, and delayed phases. In patients receiving HEC, almost all triple-drug regimens showed significantly higher complete response rates when compared to duplex antiemetic regimens. In patients with MEC, the only NK1 that showed better antiemetic effect than duplex regimens was aprepitant. Palonosetron-based regimens did not show any difference from first generation 5-HT3s for CINV complete response rate. No differences in outcomes were observed with differing doses of dexamethasone as part of a triple-drug regimen.

Conclusions

This analysis provides some key information regarding the specific selection of agents and regimens used for CINV control among patients receiving MEC and HEC. Consistent with other evidence, CINV was best controlled with a triple-drug regimen rather than a duplex regimen. The findings suggest that varied doses of dexamethasone do not reduce efficacy.

Limitations

No quality evaluation

Nursing Implications

The findings suggest that a standard triple drug regimen is more effective for CINV control with HEC regimens compared to duplex regimens. The findings also suggest that differences in dexamethasone dosing does not appear to alter antiemetic effectiveness. Regimens with reduced use of corticosteroid may be needed for patients with diabetes or low tolerance for side effects of steroids.

Legacy ID

6413